Question 1
HESI Exam-RN Health Assessment. In assessing a client’s muscle strength in the arms, the nurse observes as the client flexes both elbows fully and smoothly. Which action should the nurse take next?
- A Ask the client to lift both arms straight over the head.
- B Observe the client’s ability to smoothly adduct both forearms.
- C Document the findings in the electronic medical record.
- D Apply opposing force to the forearms while the client resists.
Question 2
When assessing a client’s skin, which finding should the nurse report to the healthcare provider (HCP)?
- A Bluish discoloration of the nailbeds.
- B Large, flat, dark red irregular area on the neck.
- C Multiple silver striae on the abdomen.
- D Multiple yellow lesions with a grainy surface.
Question 3
Nurse analyzes the assessment findings. Click to indicate which findings are indicative of rheumatoid arthritis or are not applicable to that disease. Each row must have only one response option selected.
- Morning stiffness quickly resolves: Not Applicable
- Small joints of the hand: Rheumatoid Arthritis
- Symmetrical involvement: Rheumatoid Arthritis
- Pain increases with motion: Rheumatoid Arthritis
- Heberden nodes: Not Applicable
- Fatigue and fever: Rheumatoid Arthritis
- Joint swelling: Rheumatoid Arthritis
Question 4
While completing an admission assessment for a client with fatigue, weakness, and unexplained weight loss, the nurse notes scleral jaundice. Which finding during percussion of the abdomen should the nurse document indicating hepatomegaly?
- A Tympany noted boarding the margins of the liver.
- B Areas of tympany within the liver region.
- C A dull percussion tone outside the costal margins.
- D A hollow sound over the lower abdomen.
Question 5
The nurse inserts an otoscope into a client’s ear canal. Which assessment technique is the nurse performing?
- A Percussion.
- B Auscultation.
- C Inspection.
- D Palpation.
Question 6
Which location should the nurse place the stethoscope to auscultate bronchial breath sounds? (Click on the correct location. To change, click on a new location.)
- Answer: The nurse should click on the area over the trachea (the superior, central portion of the airway located in the neck/throat area).
Question 7
An older adult male client reports nocturia with difficulty starting his urine stream. Which additional assessment should the nurse perform to obtain further data related to this information?
- A Question the client about related symptoms.
- B Inspect the urethral meatus for discharge.
- C Observe the scrotum for swelling.
- D Palpate the inguinal area for a bulge. HESI Exam-RN Health Assessment
Question 8
During assessment of the thorax and lungs, which technique should the nurse use to assess a client’s anteroposterior (AP) diameter?
- A Auscultation.
- B Percussion.
- C Palpation.
- D Inspection.
Question 9
In assessing a client’s nailbeds, the nurse notes that the angle between the nail and the nailbed is 200 degrees. Which action should the nurse take?
- A Determine the client’s most recent hemoglobin level.
- B Document the presence of nailbed clubbing.
- C Administer a PRN prescription for oxygen.
- D Consult with a podiatrist to trim the client’s toenails.
Question 10
In reading a client’s record, the nurse notes that the client is experiencing tinnitus. Which assessment provides the nurse with the information needed to evaluate the effects of this condition?
- A. Perform a hearing test.
- B. Evaluate for a loss of peripheral vision.
- C. Observe chest and upper neck for a rash.
- D. Assess deep tendon reflexes.
Question 11
To confirm the presence of steatorrhea, which action should the nurse take?
- A. Lightly palpate areas of abdominal protuberance.
- B. Inspect the area around the client’s umbilicus.
- C. Auscultate all four quadrants of the client’s abdomen.
- D. Observe the appearance of the client’s stool.
Question 12
When conducting a physical examination, the nurse uses a tuning fork to assess for which condition?
- A. Tinnitus.
- B. Neurological pathology.
- C. Hearing loss.
- D. Otitis media.
Question 13
Which can the nurse do to mitigate artifacts when performing auscultation? Select all that apply.
- A. Wet the chest hair before auscultating
- B. Ensure the room is as quiet as possible
- C. Reach under a gown to listen and take care that no clothing rubs on the stethoscope
- D. Keep the examination room warm, and warm the stethoscope
- E. Document the roaring and crackles
Question 14
A client who recently underwent a routine surgical procedure made a clinic appointment. To elicit the most information, which question is best for the nurse to ask this client?
- A. “What type of surgery did you have?”
- B. “What brought you to the clinic?”
- C. “Are you having any pain?”
- D. “When did your surgery take place?”
Question 15
The nurse is assessing a client’s skin turgor. After gently pinching up an area of skin, which action should the nurse perform next?
- A. Release and observe how quickly the skin returns to normal.
- B. Document how easily the skin area is raised.
- C. Measure the depth of the pitting in the skin.
- D. Inspect the color and texture of the skin area.
Question 16
The nurse observes that an adult client’s abdomen is round and protuberant. Which additional finding requires the most immediate follow-up assessment?
- A. Presence of multiple striae.
- B. Contour appears asymmetric.
- C. Bowel sounds audible to the ear.
- D. Large amount of adipose tissue.
Question 17
When assessing an older adult client, which finding is most indicative of dehydration?
- A. Tenting noted in subclavicular area.
- B. Loss of skin elasticity in the hand.
- C. Thinning hair in the lower extremities.
- D. Skin is warm and dry.
Question 22
During the health history, a client describes a symptom to the nurse. Which information about the symptom is best obtained by use of a numeric scale?
- A Radiation.
- B Quality.
- C Timing.
- D Severity.
Question 23
Complete the diagram by dragging from the choices area to specify cranial nerve is being assessed, two actions the nurse should take to further assess that cranial nerve, and two parameters the nurse should monitor to assess the client’s progress.
Actions to Take:
- Assess lateral eye movement
- Assess pupillary constriction
Potential Conditions:
- Cranial Nerve III
- Cranial Nerve VI
Parameters to Monitor:
- Pupil constriction
- Lateral eye movement
(Note: Based on the drag-and-drop format, the primary pair for CN III is assessing pupillary constriction and monitoring pupil constriction; for CN VI, it is assessing and monitoring lateral eye movement.)
Question 24
The nurse is performing a pulmonary assessment for an adult who arrives at the clinic for an annual physical examination. Which assessment findings should the nurse identify as a normal finding?
- A The accessory muscles are used during inspiration and expiration.
- B The costal margin is greater than 90 degrees.
- C The thorax is barrel shaped.
- D The ribs articulate at a 45-degree angle with the sternum.
Question 25 of 60
The nurse observes generalized weakness and diminished deep tendon reflexes on the right side of an older adult client who has a history of a cerebrovascular accident (CVA). Which deep tendon reflex response should the nurse document to support the client’s clinical assessment?
- A. Right side deep tendon reflex 2+.
- B. Right side deep tendon reflex 0.
- C. Right side deep tendon reflex 1+.
- D. Right side deep tendon reflex 4+.
Question 26 of 60
An older client reports difficulty reading due to blurred and distorted vision. The nurse should review the electronic medical record for which risk factor?
- A. Pancreatitis.
- B. Osteoporosis.
- C. Alcohol use.
- D. Cigarette smoking.
Question 27 of 60
A client arrives at the clinic and describes having rectal pressure, burning, and itching around the anus. During the health assessment, which technique should the nurse implement to determine if the client has hemorrhoids?
- A. Turn client laterally to palpate Bartholin’s glands.
- B. Inspect anus as the client bends over and touches the floor.
- C. Ask client to bear down while observing for rectal protrusions.
- D. Obtain a stool sample to assess for occult blood.
Question 33 of 60
The nurse is assessing a 76-year-old male client with new-onset confusion and a blood pressure of 154/90 mm Hg. Nurses’ notes indicate findings of an arterial bruit and a murmur, and a carotid ultrasound has been ordered.
Complete the diagram by selecting the appropriate actions, potential conditions, and parameters to monitor. (Match the correct items from the lists below).
Actions to Take
- Assess with bell of stethoscope
- Assess for loudness of sound
- Apply stethoscope at two levels on the neck
- Have patient lay down with head on pillow
- Compress gently one carotid at a time
Potential Conditions
- Aortic stenosis
- Arterial obstruction or aneurysm
- Transient ischemic attack
- Stroke
Parameters to Monitor
- Murmur
- Bruit
- Pulses
- Distended jugular veins
- Respirations
Answer Highlights
Based on the clinical findings of an arterial bruit and confusion, the diagram should be completed as follows:
| Actions to Take | Potential Conditions | Parameters to Monitor |
| Apply stethoscope at two levels on the neck | Arterial obstruction or aneurysm | Bruit |
| Compress gently one carotid at a time | Transient ischemic attack | Pulses |
| Assess with bell of stethoscope | Aortic stenosis | Murmur |
Question 33
The client is a 76-year-old male who was brought to the clinic by his daughter. Daughter says her otherwise healthy father is getting more confused and forgets sometimes why he goes into a room. General appearance appears healthy. Denies being ill recently. Denies chest pain or shortness of breath. Normal S1 and S2 heart sounds, normal sinus rhythm (NSR). Lungs clear to auscultation. Carotid artery assessment done. Findings reveal an arterial bruit and murmur. Findings conveyed to the healthcare provider (HCP). Prescription noted for carotid ultrasound. Complete the diagram by selecting the correct potential condition the client is most likely experiencing, the actions the nurse should take when assessing the client, and the parameters the nurse should continue to monitor.
- Actions to Take: Assess with bell of stethoscope
- Actions to Take: Apply stethoscope at two levels on the neck
- Potential Conditions: Arterial obstruction or aneurysm
- Potential Conditions: Stroke
- Parameters to Monitor: Bruit
- Parameters to Monitor: Murmur
Question 34
While assessing a client who is obese, the nurse is unable to locate the gallbladder when palpating below the liver margin at the lateral border of the rectus abdominal muscle. Which is the most likely explanation for failure to locate the gallbladder by palpation?
- A Palpating in the wrong abdominal quadrant.
- B The gallbladder is normal.
- C Deeper palpation technique is needed.
- D The client is too obese.
Question 35
When assessing a client’s abdomen, the nurse uses auscultation to assess for which possible finding?
- A Guarding.
- B Bruits.
- C Ascites.
- D Striae.
